冠状动脉联合颈动脉超声检查在高危人群前降支狭窄筛查中的价值  

The Value of Combined Coronary and Carotid Artery Ultrasonography in Screening for Left Anterior Descending Artery Stenosis in High-Risk Populations

作　　者：李星 李志勇 LI Xing;LI Zhi-yong(Department of Electrocardiography Jingdezhen City Second People’s Hospital,Jingdezhen 333000,China;Department of Ultrasonography,Jingdezhen City Second People’s Hospital,Jingdezhen 333000,China)

机构地区：[1]景德镇市第二人民医院心电功能科,江西景德镇333000 [2]景德镇市第二人民医院超声科,江西景德镇333000

出　　处：《实用临床医学(江西)》2025年第1期83-88,共6页Practical Clinical Medicine

基　　金：景德镇市科技计划项目(20231SFZC047)。

摘　　要：目的 探讨冠状动脉联合颈动脉超声检查在高危人群前降支狭窄筛查中的临床价值。方法 选取经冠状动脉造影(coronary angiography,CAG)确诊前降支(left anterior descending branch,LAD)狭窄≥50%患者64例作为研究组,按照年龄、性别进行1∶1匹配选取同期经CAG确诊LAD狭窄<50%患者64例作为对照组,总结LAD的冠状动脉超声表现,比较2组冠状动脉超声参数[包括LAD的舒张期峰值速度(diastolic peak velocity,PDV)、舒张期平均血流速度(diastolicmeanvelocity,MDV)、舒张期速度时间积分(diastolicvelocity time integral,DVTI)、狭窄处与最慢舒张期峰值速度比值(peak stenotic to prestenotic velocity ratio,pSPVR)和斑块检出率]和颈动脉超声参数[包括内中膜厚度(intima-media thickness,IMT)、Crouse积分和狭窄发生率],并分析冠状动脉联合颈动脉超声的诊断效能。结果 研究组患者冠状动脉超声表现为LAD呈不光整的管状结构,壁上可见强回声斑块致管腔变窄,探及湍流血流信号及高速血流;对照组冠状动脉超声表现为LAD管壁光整,管腔规整,部分患者尚可见强回声斑块,探及纯色层流血流信号及低速血流。研究组患者LAD的PDV、MDV、DVTI和pSPVR,以及颈动脉IMT值和Crouse积分均大于对照组(均P <0.001);研究组冠状动脉斑块检出率和颈动脉狭窄发生率均高于对照组(P <0.001,P <0.05)。以CAG为金标准,冠状动脉联合颈动脉超声诊断LAD狭窄≥50%的灵敏度为87.5%(56/64)、特异度为84.3%(54/64)、阳性预测值为84.8%(56/66)、阴性预测值为87.0%(54/62),符合率为85.9%(110/128);ROC曲线显示冠状动脉联合颈动脉超声诊断LAD狭窄≥50%的AUC为0.859。结论 LAD狭窄时冠状动脉和颈动脉超声参数均有明显异常,冠状动脉联合颈动脉超声诊断LAD狭窄具有较高的诊断效能。Objective To investigate the clinical value of combined coronary and carotid artery ultrasonography in screening for left anterior descending artery stenosis in high-risk populations.Methods This retrospective study enrolled 64 patients with≥50%stenosis in the left anterior descending branch(LAD)confirmed by coronary angiography(CAG)as the study group,with 1:1 age-and gender-matched controls(64 patients with<50%LAD stenosis confirmed by CAG).Coronary ultrasonographic features of LAD were systematically analyzed,and comparative assessments included coronary ultrasonographic parameters[LAD diastolic peak velocity(PDV),diastolic mean velocity(MDV),diastolic velocity time integral(DVTI),peak stenotic to prestenotic velocity ratio(pSPVR),and plaque detection rate]and carotid ultrasonographic indices[intima-media thickness(IMT),Crouse score,and stenosis incidence].Diagnostic performance of combined coronary and carotid ultrasonography was evaluated.Results In the study group,coronary ultrasound revealed irregular tubular structures in the LAD with hyperechoic plaques causing luminal narrowing,accompanied by turbulent flow signals and high-velocity blood flow.In contrast,the control group exhibited smooth LAD walls with regular luminal contours;some patients presented hyperechoic plaques but demonstrated homogeneous laminar flow signals and low-velocity blood flow.The study group demonstrated higher values of PDV,MDV,DVTI,pSPVR,carotid IMT,and Crouse scores compared to the control group(all P<0.001).Additionally,coronary plaque detection rates and carotid stenosis incidence were elevated in the study group(P<0.001 and P<0.05,respectively).Using CAG as the gold standard,the combined coronary and carotid ultrasound for diagnosing LAD stenosis(≥50%)showed a sensitivity of 87.5%(56/64),specificity of 84.3%(54/64),positive predictive value of 84.8%(56/66),negative predictive value of 87.0%(54/62),and overall accuracy of 85.9%(110/128).ROC analysis revealed an AUC of 0.859 for the combined ultrasound approach in diagnosin

关 键 词：冠状动脉超声 颈动脉超声 前降支狭窄 高危人群 

分 类 号：R445.1[医药卫生—影像医学与核医学]